Provider Demographics
NPI:1114606209
Name:ANDERSON, DEBORAH A (CPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5532
Mailing Address - Country:US
Mailing Address - Phone:701-840-1967
Mailing Address - Fax:
Practice Address - Street 1:518 SHADYBROOK DR
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-5532
Practice Address - Country:US
Practice Address - Phone:701-840-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health